US9192649B2 - Annexin and its use to treat inflammatory disorders - Google Patents

Annexin and its use to treat inflammatory disorders Download PDF

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US9192649B2
US9192649B2 US13/124,330 US200913124330A US9192649B2 US 9192649 B2 US9192649 B2 US 9192649B2 US 200913124330 A US200913124330 A US 200913124330A US 9192649 B2 US9192649 B2 US 9192649B2
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annexin
sepsis
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Qingping Feng
Xiangru Lu
Paul Arnold
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London Health Sciences Centre Research Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/1703—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
    • A61K38/1709—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system

Definitions

  • the present invention relates to treatment of inflammatory disorders. More particularly, the present invention relates to use of Annexin A5 for treatment of inflammatory disorders and in aspects, treatment of sepsis.
  • Abnormalities associated with inflammation comprise a large group of disorders which underly a variety of human diseases.
  • the immune system is often involved with inflammatory disorders, demonstrated in both allergic reactions and some myopathies, with many immune system disorders resulting in abnormal inflammation.
  • Non-immune diseases with aetiological origins in inflammatory processes are thought to include sepsis, cancer, atherosclerosis, and ischaemic heart disease.
  • a large variety of proteins are involved in inflammation, and altered expression and/or activity of one or more of these proteins can impair or otherwise dysregulate the normal immune function.
  • Vertebrates achieve internal homeostasis during infection or injury by balancing the activities of proinflammatory and anti-inflammatory pathways.
  • this internal homeostasis becomes out of balance.
  • endotoxin lipopolysaccharide, LPS
  • LPS lipopolysaccharide
  • Inflammatory disorders are often induced by pro-inflammatory cytokines, such as tumor necrosis factor (TNF; also known as TNF ⁇ or cachectin), interleukin (IL)-Ia, IL-I ⁇ , IL-6, IL-8, IL-18, interferon ⁇ , platelet-activating factor (PAF), macrophage migration inhibitory factor (MIF), and other compounds.
  • TNF tumor necrosis factor
  • IL-Ia interleukin
  • IL-I ⁇ interleukin ⁇
  • IL-6 interleukin
  • IL-8 interferon ⁇
  • PAF platelet-activating factor
  • MIF macrophage migration inhibitory factor
  • Pro-inflammatory cytokines contribute to various disorders through their release during an inflammatory cytokine cascade.
  • composition comprising an effective amount of Annexin A5 for use in treatment of an inflammatory disorder.
  • a therapeutic pharmaceutical composition comprising an effective amount of Annexin A5 for treatment of an inflammatory disorder.
  • composition comprising an effective amount of Annexin A5 for use in treatment of organ dysfunction.
  • a therapeutic pharmaceutical composition comprising an effective amount of Annexin A5 for use in treatment of sepsis.
  • composition comprising an effective amount of Annexin A5 for use in the improvement of cardiac function during endotoxemia.
  • composition may further comprise one or more pharmaceutical agents.
  • Annexin A5 for preparation of a medicament.
  • Annexin A5 for preparation of a medicament for treatment of an inflammatory disorder.
  • Annexin A5 for preparation of a medicament for treatment of organ dysfunction, in aspects, cardiac dysfunction.
  • Annexin A5 for preparation of a medicament for treatment of sepsis in a subject.
  • a method of treating an inflammatory disorder in a subject comprising administering an effective amount of Annexin A5 to the subject.
  • a method for treatment of organ dysfunction in a subject comprising administering an effective amount of Annexin A5 to the subject.
  • a method for the treatment of sepsis in a subject comprising administering an effective amount of an Annexin to said mammal.
  • the Annexin is Annexin A5.
  • Annexin A5 for preparation of a medicament for improving organ function in a subject.
  • composition comprising an effective amount of Annexin A5 for improving organ function.
  • a method for improving organ function in a subject comprising administering an effective amount of Annexin A5 to the subject.
  • kits comprising Annexin A5 and a pharmaceutically acceptable carrier, and instructions for preparing a medicament comprising Annexin A5 and/or instructions for administering Annexin A5 for treatment of an inflammatory disorder.
  • kits comprising Annexin A5 and a pharmaceutically acceptable carrier, and instructions for preparing a medicament comprising Annexin A5 and/or instructions for administering Annexin A5 for treatment of organ dysfunction in a subject.
  • FIG. 1 shows an effect of Annexin A5 administration on cardiac function in mice with endotoxemia
  • FIG. 2 shows an effect of Annexin A5 administration on myocardial TNF- ⁇ mRNA expression in mice with endotoxemia
  • FIG. 3 shows an effect of Annexin A5 administration on myocardial TNF- ⁇ protein expression in mice with endotoxemia.
  • FIG. 4 confirms the experiment of FIG. 1 in that Annexin A5 (A5) improves in vivo cardiac function in mice with endotoxemia.
  • Mice were treated with saline (control, 100 ⁇ L, i.p), A5 (5 ⁇ g/kg i.v.), LPS (4 mg/kg i.p.) or LPS plus A5 for 4 hours.
  • A5 treatment significantly increased LV +dP/dt and ⁇ dP/dt in mice with endotoxemia.
  • FIG. 5 shows Annexin A5 (A5) improves ex vivo cardiac function in mice with endotoxemia.
  • Mice were treated with saline (control, 100 ⁇ L, i.p), A5 (5 ⁇ g/kg i.v.), LPS (4 mg/kg i.p.) or LPS plus A5 for 4 hours.
  • A5 treatment significantly increased +dF/dt, ⁇ dF/dt and heart work in mice with endotoxemia.
  • FIGS. 6A-D show the effects of annexin A5 (A5) on TNF- ⁇ and IL-1 ⁇ production in endotoxemic mice.
  • Mice were treated with saline (control, 100 ⁇ L, i.p), A5 (5 ⁇ g/kg i.v.), LPS (4 mg/kg i.p.) or LPS plus A5 for 4 hours.
  • a and B Treatment with A5 (5 ⁇ g/kg, i.v.) significantly decreased myocardial TNF- ⁇ mRNA and protein expression during endotoxemia.
  • C and D Plasma levels of TNF- ⁇ and IL- ⁇ were significantly decreased by A5 treatment during endotoxemia.
  • FIGS. 7A and B show that Annexin A5 (A5) decreases myocardial p38 and ERK1/2 MAPK phosphorylation during endotoxemia.
  • Mice were treated with saline (control, 100 ⁇ L i.p), A5 (5 ⁇ g/kg i.v.), LPS (4 mg/kg i.p.) or LPS plus A5 for 30 minutes.
  • A Myocardial p38 phosphorylation.
  • B ERK1/2 phosphorylation.
  • FIGS. 8A and B show that Annexin A5 (A5) inhibits TNF- ⁇ and IL-1 ⁇ mRNA expression in adult cardiomyocytes.
  • Adult cardiomyocytes were cultured on 35 mm dishes. Cells were treated with LPS (2.5 ⁇ g/ml) in the presence or absence of A5 (1 ⁇ g/ml) for 6 hours.
  • FIG. 9 shows that Annexin A5 interacts with TLR4 in myocardial tissue as determined by co-immunoprecipitation analysis.
  • Myocardial tissue was homogenized and incubated with 0.5 ⁇ g annexin A5.
  • TLR4 protein was pulled down using magnetic beads coated with anti-TLR4 antibody. This was followed by a Western blot analysis for annexin A5.
  • Lane 1 a control myocardial sample from mice treated with saline.
  • Lane 2 myocardial sample from LPS treated mice (4 mg/kg, i.p. for 4 hours).
  • the blot shown is a representative from 3 experiments.
  • compositions for treatment of inflammatory disorders are described herein. More specifically, methods and compositions comprising use of Annexin A5 for treatment of inflammatory disorders are described herein.
  • the disorder is sepsis.
  • treatment includes prophylactic and therapeutic treatment.
  • “Prophylactic treatment” refers to treatment of a subject before onset of an inflammatory condition to prevent, inhibit or reduce its occurrence.
  • Therapeutic treatment is treatment of a subject who is already experiencing an inflammatory disorder.
  • a “subject” may be any vertebrate animal, but will typically pertain to a mammal, for example a human patient, a domesticated animal (such as dog or cat), a farm animal (such as horse, cow, or sheep) or a laboratory animal (such as rat, mouse, non-human primate or guinea pig). In certain examples, the subject is human.
  • Inflammatory disorders are usually mediated by an inflammatory cytokine cascade, defined herein as an in vivo release from cells of at least one proinflammatory cytokine in a subject, wherein the cytokine release affects a physiological condition of the subject.
  • cytokine cascade defined herein as an in vivo release from cells of at least one proinflammatory cytokine in a subject, wherein the cytokine release affects a physiological condition of the subject.
  • Non-limiting examples of cells that produce proinflammatory cytokines are monocytes, macrophages, neutrophils, epithelial cells, osteoblasts, fibroblasts, smooth muscle cells, and neurons.
  • a “cytokine” is a soluble protein or peptide which is naturally produced by mammalian cells and which act in vivo as humoral regulators at micro- to picomolar concentrations. Cytokines can, either under normal or pathological conditions, modulate the functional activities of individual cells and tissues.
  • a proinflammatory cytokine is a cytokine that is capable of causing any of the following physiological reactions associated with inflammation: vasodialation, hyperemia, increased permeability of vessels with associated edema, accumulation of granulocytes and mononuclear phagocytes, or deposition of fibrin.
  • Non-limiting examples of proinflammatory cytokines are tumor necrosis factor alpha (TNF), interleukin (IL)-Ia, IL-I-beta, IL-6, IL-8, IL-18, interferon-gamma, HMG-1, platelet-activating factor (PAF), and macrophage migration inhibitory factor (MIF).
  • TNF tumor necrosis factor alpha
  • IL interleukin
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I-beta
  • IL-6 interleukin-I
  • Proinflammatory cytokines are to be distinguished from anti-inflammatory cytokines, such as IL-4, IL-10, and IL-13, which are not mediators of inflammation. In certain examples, release of anti-inflammatory cytokines is not inhibited by the Annexin A5 treatment described herein.
  • the Annexin A5 treatment described herein inhibits the proinflammatory effect of TNF.
  • TNF serves as a mediator in various inflammatory disorders.
  • a few such examples include: septic shock, cancer, AIDS, transplantation rejection, multiple sclerosis, diabetes, rheumatoid arthritis, trauma, malaria, meningitis, ischemia-reperfusion injury, and adult respiratory distress syndrome.
  • TNF plays a role in several inflammatory disorders, and thus research has been conducted concerning TNF therapies and anti-TNF therapies. Research has focused upon inhibition of TNF activity in such inflammatory disorders as rheumatoid arthritis, Crohn's disease, AIDS, bacterial septic shock (caused by certain gram negative bacteria), and bacterial toxic shock (caused by superantigens) as well as in prevention of alloreactivity and graft rejection. Mutant mice that lack TNF are resistant to gram-negative bacteria induced sepsis (Janeway, C., Travers, P., Walport, M., Capra, J. Immunobiology: The Immune System in Health and Disease. New York, N.Y.: Garland Publishers.
  • TNF activity has been used to inhibit TNF activity and treat endotoximia (Beutler, B., Milsark, L., Cerami, A. 1985. Passive Immunization Against Cachectin/Tumor Necrosis Factor Protects Mice from Lethal Effects of Endotoxin. Science 229; 867-871).
  • One advantage of treatment to control TNF activity results from its role in multiple types of inflammation. For example, it is often difficult to determine that inflammation in burn and trauma victims are of infectious etiology and warrant treatment with antibiotics; therefore treatment to inhibit TNF activity may be beneficial.
  • TNF activity includes neutralization of the cytokine via either anti-TNF antibodies, soluble receptors, or receptor fusion proteins; suppression of TNF-A synthesis via drugs such as cyclosporine A, glucocorticoids, or cytokine IL-10; reduction of responsiveness to TNF via repeated low dose stimulation; or by inhibition of secondary mediators such as IL-1, IL-6, or nitric oxide.
  • Annexin A5 treatment described herein can be used to inhibit TNF activity.
  • treatment encompasses at least a small but measurable decrease in the symptoms associated with the disorder being treated as a result of Annexin A5 administration.
  • An inflammatory disorder can be one where an inflammatory cytokine cascade causes a systemic reaction, such as with systemic inflammatory response syndrome (SIRS) or septic shock.
  • the disorder can be mediated by a localized inflammatory cytokine cascade, as in rheumatoid arthritis.
  • Non-limiting examples of conditions which can be usefully treated using the Annexin A5 treatment described herein include appendicitis, peptic ulcer, gastric ulcer, duodenal ulcer, peritonitis, pancreatitis, ulcerative colitis, pseudomembranous colitis, acute colitis, ischemic colitis, diverticulitis, epiglottitis, achalasia, cholangitis, cholecystitits, hepatitis, Crohn's disease, enteritis, Whipple's disease, allergy, anaphylactic shock, immune complex disease, multiple organ dysfunction syndrome (MODS), organ ischemia, reperfusion injury, organ necrosis, hay fever, systemic inflammatory response syndrome (SIRS), sepsis, septicemia, endotoxic shock, cachexia, hyperpyrexia, eosinophilic granuloma, granulomatosis, sarcoidosis, septic abortion, epididymitis, vaginitis, prost
  • the inflammatory disorder is selected from asthma, allergy, anaphylactic shock, multiple organ dysfunction syndrome (MODS), organ ischemia, ischaemia-reperfusion injury, organ necrosis, SIRS, sepsis, septicemia, endotoxic shock, cachexia, septic abortion, disseminated bacteremia, burns, coeliac disease, congestive heart failure, myocarditis, myocardial ischemia adult respiratory distress syndrome, cerebral infarction, cerebral embolism, spinal cord injury, paralysis, allograft rejection or graft-versus-host disease.
  • MODS multiple organ dysfunction syndrome
  • organ ischemia ischaemia-reperfusion injury
  • organ necrosis SIRS
  • SIRS sepsis
  • septicemia endotoxic shock
  • cachexia cachexia
  • septic abortion disseminated bacteremia
  • burns coeliac disease
  • congestive heart failure myocarditis
  • myocardial ischemia adult respiratory distress syndrome cerebral infarction
  • cerebral embolism
  • the inflammatory disorder is endotoxic shock.
  • the inflammatory disorder is SIRS.
  • the inflammatory disorder is sepsis.
  • the inflammatory disorder is multiple organ dysfunction syndrome (MODS).
  • Annexin A5 that may be used to improve organ function (for example, heart, liver, lung, kidney, or brain) during sepsis. Annexin A5 may also be used to treat systemic organ injuries during systemic inflammatory response syndrome (SIRS) and trauma, or injuries involving ischemia and reperfusion.
  • SIRS systemic inflammatory response syndrome
  • Sepsis is a systemic inflammatory response to infection and the most common cause of death in intensive care units. Mortality is 20-30% in sepsis and 40-80% in septic shock [1]. Myocardial dysfunction is a common complication of septic shock [2].
  • This systemic inflammatory disorder is a result of a dysregulated host response to infection and is characterized by excessive pro-inflammatory cytokine production. Initiation of the host's innate immune response is mediated through the activation of the cell membrane toll-like receptor-4 (TLR4) in recognizing pathogen-associated molecular patterns (PAMPs).
  • TLR4 cell membrane toll-like receptor-4
  • Lipopolysaccharide is the most prominent PAMP in the outer membrane of Gram-negative bacteria and binds to TLR4 in a CD-14 and LPS binding protein (LBP) dependent manner. Activation of TLR4 upon LPS binding initiates a signalling pathway that leads to the activation of the mitogen-activated protein kinases (MAPK) and production of TNF, a prominent cytokine which is a major contributing factor in organ dysfunction (for example, cardiac dysfunction) in sepsis [3, 4].
  • MPK mitogen-activated protein kinases
  • Sepsis is considered present if infection is highly suspected or proven and two or more of the following systemic inflammatory response syndrome (SIRS) criteria are met (Bone R C, Balk R A, Cerra F B, et at (June 1992). “Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine”. Chest 101 (6): 1644-55.):
  • Fever and leukocytosis are features of the acute phase reaction, while tachycardia is often the initial sign of hemodynamic compromise. Tachypnea may be related to the increased metabolic stress due to infection and inflammation, but may also be a sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism.
  • SIRS criteria must be interpreted carefully within the clinical context. These criteria exist primarily for the purpose of more objectively classifying critically-ill patients so that future clinical studies may be more rigorous and more easily reproducible.
  • RNA samples there must be an infection suspected or proven (by culture, stain, or polymerase chain reaction (PCR)), or a clinical syndrome pathognomonic for infection.
  • Specific evidence for infection includes WBCs in normally sterile fluid (such as urine or cerebrospinal fluid (CSF), evidence of a perforated viscus (free air on abdominal x-ray or CT scan, signs of acute peritonitis), abnormal chest x-ray (CXR) consistent with pneumonia (with focal opacification), or petechiae, purpura, or purpura fulminans
  • sepsis The more critical subsets of sepsis are severe sepsis (sepsis with acute organ dysfunction) and septic shock (sepsis with refractory arterial hypotension).
  • SIRS systemic inflammatory response syndrome criteria
  • patients with SIRS and acute organ dysfunction may be termed “severe SIRS.”
  • Patients are defined as having “severe sepsis” if they have sepsis plus signs of systemic hypoperfusion: either organ dysfunction or a serum lactate greater than 4 mmol/dL. Other signs include oliguria and altered mental status. Patients have also been defined as having septic shock if they have sepsis plus hypotension after aggressive fluid resuscitation (typically upwards of 6 liters or 40 ml/kg of crystalloid).
  • end-organ dysfunction examples include the following (Abraham E, Singer M (2007). “Mechanisms of sepsis-induced organ dysfunction”. Crit. Care Med. 35 (10): 2408-16):
  • Annexin A5 treatment described herein is not intended for treatment of a blood coagulation disorder such as disseminated intravascular coagulation (DIC).
  • Annexin A5 is used to treat an inflammatory disorder, such as sepsis, at an early stage to prevent occurrence of a blood coagulation disorder such as disseminated intravascular coagulation (DIC).
  • compositions and methods described herein will comprise an Annexin molecule, and more typically an Annexin polypeptide.
  • compositions comprising an Annexin A5 molecule are provided.
  • Annexin A5 is a 35 kDa phospholipid binding protein which is part of a 13 member protein family (Table 1, Gerke et al., Physiol Review 2002; 82:331-371). It binds to anionic phospholipids (eg. phosphatidylserine) on the plasma membrane in a calcium dependent manner and demonstrates anti-apoptotic and anti-coagulant properties by forming a protective 2D crystallized shield over the surface of cells where phosphatidylserine is exposed [Reutelingsperger et al., Cell Mol Life Sci 1997; 53:527-532]. This protective shield sequesters the phospholipid sites where extracellular factors complex and decreases their ability to initiate phagocytosis or thrombosis.
  • anionic phospholipids eg. phosphatidylserine
  • Annexin A5 is used in some diagnostic methods and products, with some examples provided by the following companies:
  • Annexin A5 is also known as: placental anticoagulant protein I (Tait et al. Phospholipid binding properties of human placental anticoagulant protein-I, a member of the lipocortin family. J Biol Chem. 1989 May 15; 264(14):7944-9; Grundmann et al. Characterization of cDNA encoding human placental anticoagulant protein (PP4): homology with the lipocortin family. Proc Natl Acad Sci USA. 1988 June; 85(11): 3708-12); vascular anticoagulant-alpha (Andree et al. 1990. Binding of vascular anticoagulant alpha (VAC alpha) to planar phospholipid bilayers. J Biol Chem.
  • endonexin II (Schaepfer et al. 1987. Structural and functional characterization of endonexin II, a calcium- and phospholipid-binding protein. PNAS USA 84: 6078-6082); lipocortin V (Rothhut et al. A 32 kDa lipocortin from human mononuclear cells appears to be identical with the placental inhibitor of blood coagulation. Biochem J. 1989 Nov. 1; 263(3): 929-35); placental protein 4 (Inaba et al. Clinical significance of a new membrane associated placental protein 4 (PP4) in gynecologic malignancies.
  • PP4 membrane associated placental protein 4
  • anchorin CII Mollenhauer et al. Role of anchorin CII, a 31,000-mol-wt membrane protein, in the interaction of chondrocytes with type II collagen. J Cell Biol. 1984 April; 98(4):1572-9; von der Mark et al. Anchorin CII, a type II collagen-binding glycoprotein from chondrocyte membranes. Ann NY Acad Sci. 1985; 460:214-23; Mauch et al. A defective cell surface collagen-binding protein in dermatosparactic sheep fibroblasts. J Cell Biol. 1988 January; 106(1):205-11; Pilar et al. The structure of anchorin CII, a collagen binding protein isolated from chondrocyte membrane. J Biol Chem. 1988 Apr. 25; 263(12):5921-5).
  • Annexin A5 treatment described herein is demonstrated to treat an inflammatory disorder by inhibition of a proinflammatory cytokine, such as TNF ⁇ .
  • Annexin A5 treatment as described herein is not intended as an anti-coagulant. Accordingly, in certain examples Annexin A5 is used to treat organ dysfunction in an inflammatory disorder independent of an anti-coagulant effect.
  • compositions comprising an Annexin A5 molecule may be useful to treat an inflammatory disorder.
  • Compositions comprising an Annexin A5 molecule may be useful to improve organ function (for example, heart, liver, lung, kidney, or brain) in a subject suffering from an inflammatory disorder.
  • Compositions comprising an Annexin A5 molecule may also be useful to treat an inflammatory disorder associated with production of a cytokine (for example, TNF ⁇ ).
  • Compositions comprising an Annexin A5 molecule may also be useful for treatment of organ (for example, heart, liver, lung, kidney, or brain) dysfunction or injury during SIRS or sepsis.
  • compositions comprising an Annexin A5 molecule may also be useful for treatment of organ (for example, heart, liver, lung, kidney, or brain) dysfunction or injury during ischemia or reperfusion.
  • Compositions comprising an Annexin A5 molecule may also be useful for treatment of sepsis to prevent occurrence of DIC.
  • compositions comprising an Annexin A5 molecule may be used to treat any disorder where the inhibition of a proinflammatory cytokine provides a prophylactic and/or therapeutic benefit.
  • a method for treating an inflammatory disorder in a subject comprises administering an amount of Annexin A5 molecule effective to inhibit activity of a proinflammatory cytokine (for example, TNF- ⁇ ).
  • the Annexin A5 molecule may be a full-length naturally occurring polypeptide or a variant thereof, or may be a nucleic acid molecule encoding an Annexin A5 polypeptide or variant thereof. Furthermore, a recombinant cell producing the Annexin A5 molecule is provided.
  • An Annexin A5 polypeptide may be provided by any source or method, for example, natural isolate or recombinant or synthetic origin or suitable combinations thereof. Administration of the Annexin A5 polypeptide to a subject can be used to treat an inflammatory disorder, and more specifically to treat organ dysfunction in an inflammatory disorder.
  • the Annexin A5 polypeptide will be administered in an amount effective to inhibit a proinflammatory cytokine, such as TNF ⁇ .
  • the Annexin A5 polypeptide may be of any length provided that its anti-inflammatory activity is maintained.
  • the sequence of the Annexin A5 polypeptide may be based on a complete or partial naturally occurring amino acid sequence.
  • Annexin A5 polypeptide may be used either singly or in combination with other polypeptides, anti-inflammatory or otherwise, in the preparation of a composition that treats an inflammatory disorder or treats organ dysfunction in an inflammatory disorder.
  • a polypeptide refers to a chain of amino acids, for example peptides, oligopeptides, or proteins, having a biological function, and does not refer to a specific length of the chain.
  • An isolated Annexin A5 polypeptide is a polypeptide that has been identified and separated and/or recovered from at least one component of its natural environment.
  • the isolated polypeptide will typically have been purified by at least one purification step, and, in some embodiments purification may be achieved (1) to a degree sufficient to obtain at least 15 residues of N-terminal or internal amino acid sequence by use of a sequenator, or (2) to homogeneity by SDS-PAGE under non-reducing or reducing conditions using Coomassie blue or, preferably, silver stain.
  • Isolated polypeptide includes polypeptide in situ within recombinant cells, since at least one component of the Annexin A5 polypeptide natural environment will not be present.
  • An isolated polypeptide may be produced by synthetic or recombinant techniques, for example as described in J. Sambrook, E. F. Fritsch, and T. Maniatis, 1989, Molecular Cloning: A Laboratory Manual, Second Edition, Books 1-3, Cold Spring Harbor Laboratory Press.
  • An isolated polypeptide produced as a result of recombinant techniques may be referred to as a recombinant polypeptide.
  • a nucleic acid encoding an Annexin A5 polypeptide may be any nucleic acid molecule of, for example. cDNA, genomic DNA, synthetic DNA or RNA origin or suitable combinations thereof.
  • Administration of the nucleic acid encoding an Annexin A5 polypeptide to a subject can be used to treat an inflammatory disorder, and more specifically to treat organ dysfunction in an inflammatory disorder.
  • the Annexin A5 nucleic acid will be administered in an amount effective to inhibit a proinflammatory cytokine, such as TNF.
  • the nucleic acid may be of any length provided that the anti-inflammatory activity is maintained by the encoded Annexin A5 polypeptide.
  • sequence of the nucleic acid encoding an Annexin A5 polypeptide may be based on a complete or partial naturally occurring nucleic acid sequence.
  • a nucleic acid sequence encoding an Annexin A5 polypeptide may be used either singly or in combination with other nucleic acid sequences, encoding anti-inflammatory polypeptides or encoding any other desired polypeptide, in the preparation of a composition that treats an inflammatory disorder or treats organ dysfunction in an inflammatory disorder.
  • An isolated nucleic acid molecule encoding an Annexin A5 polypeptide is a nucleic acid molecule that is identified and separated from at least one contaminant nucleic acid molecule with which it is ordinarily associated in the natural source of the nucleic acid. Such an isolated nucleic acid molecule is other than in the form or setting in which it is found in nature. Isolated nucleic acid molecules therefore are distinguished from the nucleic acid molecule as it exists in natural cells.
  • An isolated nucleic acid molecule encoding an Annexin A5 polypeptide includes nucleic acid molecule encoding an Annexin A5 polypeptide contained in cells that ordinarily express the Annexin A5 polypeptide where, for example, the nucleic acid molecule is in a chromosomal or extrachromosomal location different from that of natural cells.
  • the isolated nucleic acid molecule may be referred to as a recombinant nucleic acid molecule where the isolated nucleic acid molecule has been manipulated using recombinant techniques, for example, as described in J. Sambrook, E. F. Fritsch, and T. Maniatis, 1989, Molecular Cloning: A Laboratory Manual, Second Edition, Books 1-3, Cold Spring Harbor Laboratory Press.
  • Variants include, without limitation, analogs, derivatives, fragments, truncations, splice variants, mutants, deletions, substitutions, insertions, fusions and the like.
  • An Annexin A5 polypeptide or a nucleic acid encoding an Annexin A5 polypeptide may be mutated or changed or derivatised in any manner desired (for example, any number or combination of deletions, insertions, or substitutions) to produce a corresponding variant.
  • Use of such variants in treatment of an inflammatory disorder or treatment of organ dysfunction in an inflammatory disorder is contemplated, and such a variant nucleic acid or variant polypeptide may be mutated or changed or derivatised in any manner in comparison to a naturally occurring nucleic acid or polypeptide sequence, respectively, provided that the anti-inflammatory activity is maintained.
  • a composition may comprise an Annexin A5 polypeptide having a sequence that is identical to a naturally-occurring form of the Annexin A5 polypeptide or a variant thereof that has a sequence that is at least 80% identical to a naturally-occurring form of the Annexin A5 polypeptide.
  • a composition may comprise a nucleic acid molecule having a coding sequence that is identical to a naturally-occurring form of the coding sequence or a variant thereof that has a sequence that is at least 70% identical to a naturally-occurring form of the coding sequence. Determination of sequence identity of proteins and nucleic acids by computer based methods, as well as nucleic acid hybridization techniques using high stringency conditions for determining or identifying nucleic acid sequences that share high (eg., at least 70%) sequence identity are well known to the skilled person.
  • Hybridization generally depends on the ability of denatured DNA to reanneal when complementary strands are present in an environment below their melting temperature. The higher the degree of sequence identity between the probe and hybridizable sequence, the higher the relative temperature which can be used.
  • High stringency conditions may be identified by those that: (1) employ low ionic strength and high temperature for washing, for example 0.015 M sodium chloride/0.0015 M sodium citrate/0.1% sodium dodecyl sulfate at 50° C.; (2) employ during hybridization a denaturing agent, such as formamide, for example, 50% (v/v) formamide with 0.1% bovine serum albumin/0.1% Ficoll/0.1% polyvinylpyrrolidone/50 mM sodium phosphate buffer at pH 6.5 with 750 mM sodium chloride, 75 mM sodium citrate at 42° C.; or (3) employ 50% formamide, 5 ⁇ SSC (0.75 M NaCl, 0.075 M sodium citrate), 50 mM sodium phosphate (pH 6.8), 0.1% sodium pyrophosphate, 5 ⁇ Denhardt's solution, sonicated salmon sperm DNA (50 ⁇ g/ml), 0.1% SDS, and 10% dextran sulfate at 42° C., with washes
  • Percent (%) sequence identity of amino acid or nucleic acid sequences with respect to Annexin A5 polypeptides and nucleic acid sequences encoding Annexin A5 polypeptides is the percentage of residues in a candidate sequence that are identical with the Annexin A5 polypeptide amino acid sequence or the Annexin A5 polypeptide-encoding nucleic acid sequence, as the case may be, after aligning the sequences and introducing gaps, if necessary, to achieve the maximum percent sequence identity.
  • Alignment for purposes of determining percent amino acid sequence identity or percent nucleic acid sequence identity can be achieved in various ways that are within the skill in the art, for instance, using publicly available computer software such as BLAST, BLAST-2, ALIGN, ALIGN-2 or Megalign (DNASTAR) software. Those skilled in the art can determine appropriate parameters for measuring alignment, including any algorithms needed to achieve maximal alignment over a desired length of sequence, for example, at least 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 residues or even the full-length of the sequences being compared.
  • the variant annexin A5 polypeptide will typically have an amino acid sequence that is at least 80, 82, 84, 86, 88, 90, 92, 94, 96, or 98 percent identical to the corresponding Annexin A5 polypeptide.
  • the variant nucleic acid sequence will typically be at least 70, 72, 74, 76, 78, 80, 82, 84, 86, 88, 90, 92, 94, 96, or 98 percent identical to the corresponding nucleic acid encoding the Annexin A5 polypeptide.
  • an Annexin A5 polypeptide may be modified in vivo or in vitro by, glycosylation, amidation, phosphorylation, carboxylation, truncation, fragmentation, substitution, and the like without eliminating anti-inflammatory activity.
  • substitution mutations can be made in a nucleic acid encoding an Annexin A5 polypeptide such that a particular codon is changed to a codon which codes for a different amino acid.
  • a substitution mutation of this sort can be made to change an amino acid in the resulting protein in a non-conservative manner (i.e., by changing the codon from an amino acid belonging to a grouping of amino acids having a particular size or characteristic to an amino acid belonging to another grouping) or in a conservative manner (i.e. by changing the codon from an amino acid belonging to a grouping of amino acids having a particular size or characteristic to an amino acid belonging to the same grouping).
  • a conservative change generally leads to less change in the structure and function of the resulting protein.
  • a non-conservative change is more likely to alter the structure, activity or function of the resulting protein.
  • Groupings of amino acids are known to the skilled person.
  • the nonpolar (hydrophobic) amino acids include alanine, leucine, isoleucine, valine, proline, phenylalanine, tryptophan and methionine.
  • Amino acids containing aromatic ring structures are phenylalanine, tryptophan, and tyrosine.
  • the polar neutral amino acids include glycine, serine, threonine, cysteine, tyrosine, asparagine, and glutamine.
  • the positively charges (basic) amino acids include arginine, lysine and histidine.
  • the negatively charged (acidic) amino acids include aspartic acid and glutamic acid. Any number of such substitutions or any other type of alteration (eg., deletion or insertion) or modification may be tolerated provided that the anti-inflammatory effect is not eliminated.
  • Recombinant cells comprising an Annexin A5 polypeptide or a nucleic acid sequence that encodes an Annexin A5 polypeptide may be used for treatment of an inflammatory disorder or treatment of organ dysfunction in an inflammatory disorder.
  • Recombinant cell types may include any cell type that is compatible with the physiology of an intended subject selected for treatment.
  • a cell may be altered or modified to comprise a nucleic acid sequence that does not naturally occur in the cell, and as such the cell will be considered recombinant.
  • a cell may be altered or modified to comprise an additional copy of a nucleic acid sequence that naturally occurs in the cell, and such cells will also be considered recombinant.
  • a nucleic acid encoding an Annexin A5 polypeptide may be introduced into a cell using any known technique, for example, microinjection, electroporation, viral transfection, lipofectamine transfection, calcium phosphate precipitation and the like.
  • a stem cell may be modified by introduction of a nucleic acid molecule encoding an Annexin A5 polypeptide, and then the modified cells may be administered to a subject.
  • a nucleic acid molecule encoding an Annexin A5 polypeptide may be incorporated into an appropriate construct or vehicle, for example a viral construct, and administered to a subject such that the nucleic acid molecule encoding the Annexin A5 polypeptide is introduced and expressed in at least a portion of the cells of the subject.
  • a nucleic acid encoding an Annexin A5 polypeptide may be operably linked to control sequences, typically in the context of a suitable vector.
  • a useful control sequence may be any nucleic acid element that is necessary or advantageous for expression of the coding sequence of the nucleic acid sequence.
  • Each control sequence may be native or foreign to the nucleic acid sequence encoding the Annexin A5 polypeptide.
  • control sequences include, but are not limited to, a leader, a polyadenylation sequence, a propeptide sequence, a promoter, a signal sequence, or a transcription terminator. Alternatives for incorporating control sequences are readily available to the skilled person.
  • a nucleic acid encoding an Annexin A5 polypeptide may be under the control of an endogenous upstream promoter, or it may be put under control of a heterologous upstream promoter.
  • suitable promoters for directing the transcription of an Annexin A5 nucleotide sequence in a bacterial host include the promoter of the lac operon of E.
  • the Streptomyces coelicolor agarase gene dagA promoters the promoters of the Bacillus licheniformis alpha-amylase gene (amyl), the promoters of the Bacillus stearothermophilus maltogenic amylase gene (amyM), the promoters of the Bacillus amyloliquefaciens alpha-amylase gene (amyQ), the promoters of the Bacillus subtilis xylA and xylB genes, the promoter of the Bacillus subtilis aprE gene and a promoter derived from a Lactococcus sp.—derived promoter including the P170 promoter.
  • a suitable promoter can be selected, for example, from a bacteriophage promoter including a T7 promoter and a phage lambda promoter.
  • examples of useful promoters are those derived from the genes encoding the, Aspergillus oryzoe TAKA amylase, Rhizomucor miehei aspartic proteinase, Aspergillus niger neutral alpha-amylase, A. niger acid stable alpha-amylase, A. niger glucoamylase, Rhizomucor miehei lipase, Aspergillus oryzoe alkaline protease, Aspergillus oryzoe triose phosphate isomerase or Aspergillus nidulons acetamidase.
  • Suitable promoters for the expression in a yeast species include but are not limited to the Gal 1 and Gal 10 promoters of Saccharomyces cerevisiae and the Pichia pastoris AOX1 or AOX2 promoters.
  • promoters are available to the skilled person, for example, cytomegalovirus, Rous Sarcoma Virus, synthetic pox viral promoter, pox synthetic late promoter 1, pox synthetic late promoter 2 early promoter 2, pox 01L promoter, pox 14L promoter, pox 13L promoter; pox 12L promoter, pox IIL promoter, pox DIOR promoter, PRV gX, HSV-1 alpha 4, chicken beta-actin promoter, HCMV immediate early, MDV gA, MDV gB, MDV gD, ILT gB, BHV-1.1 VP8 and ILT gD and internal ribosomal entry site promoter.
  • a suitable vector may be any vector (for example, a plasmid or virus) which can incorporate a nucleic acid sequence encoding an Annexin A5 polypeptide and any desired control sequences and can bring about the expression of the nucleic acid sequence.
  • the choice of the vector will typically depend on the compatibility of the vector with a host cell into which the vector is to be introduced.
  • the vector may exist as an extrachromosomal entity, with replication being independent of chromosomal replication, for example, a plasmid, an extrachromosomal element, a minichromosome, or an artificial chromosome.
  • the vector may be one which, when introduced into the host cell, is integrated into the genome and replicated together with the chromosome(s) into which it has been integrated. Still other examples of vectors and techniques for manipulating vectors will be known and apparent to the skilled person.
  • Recombinant cells may comprise an Annexin A5 polypeptide or a nucleic acid sequence encoding an Annexin A5 polypeptide, either singly or in combination, with other desired polypeptide or nucleic acid molecules, respectively, for example to optimize or enhance efficacy.
  • a nucleic acid sequence may be mutated or altered prior to introduction into the cells as desired, for example for codon optimization for expression in a particular cell type.
  • a nucleic acid sequence may be altered to encoded a fusion of an Annexin A5 polypeptide with one or more other polypeptide(s) as desired in an application, for example fusion with a targeting polypeptide or a carrier polypeptide.
  • Annexin A5 molecules and cells comprising Annexin A5 molecules can apply equally to other polypeptides, nucleic acid molecules, and cells that are used in combination with Annexin A5 molecules and cells comprising Annexin A5 molecules.
  • anti-inflammatory polypeptides, nucleic acid molecules encoding anti-inflammatory polypeptides or cells producing anti-inflammatory polypeptides may be used in combination with Annexin A5 molecules or cells producing Annexin A5 molecules.
  • an Annexin A5 molecule is used in combination with an Annexin 1 molecule.
  • administration of polypeptides, nucleic acid molecules, or cells can be done in a variety of manners.
  • administration may be done intramuscularly, subcutaneously, intravenously, intranasally, intradermaly, intrabursally, in ovo, ocularly, orally, intra-tracheally or intra-bronchially, as well as combinations of such modalities.
  • the dose may vary with the size of the intended subject.
  • Methods of administration are known to the skilled person, for example, see U.S. Pat. Nos. 5,693,622; 5,589,466; 5,580,859; and 5,566,064.
  • the amounts of polypeptide, nucleic acid sequence, or recombinant cell needed for preparation of a composition is well understood by one of skill in the art.
  • Therapeutically effective amounts can also be determined in animal studies.
  • the applied dose of Annexin A5 can be adjusted based on the relative bioavailability and potency of the administered compounds, including the adjuvants used. Adjusting the dose to achieve maximal efficacy based on the methods described above and other methods are well within the capabilities of the ordinarily skilled artisan.
  • Subject doses of Annexin A5 as described herein may typically range from about 0.1 . ⁇ g to 10,000 mg, more typically from about 1 . ⁇ g/day to 8000 mg, even more typically from about 10 . ⁇ g to 5 mg, and most typically from about 10 ⁇ g to 100 pg.
  • typical dosages range from about 0.1 ⁇ g to 20 mg/kg/day, more typically from about 1 to 10 mg/kg/day, and most typically from about 1 to 5 mg/kg/day although daily doses may be more than 20 mg/kg/day or less than 0.1 . ⁇ g/kg/day.
  • the Annexin A5 may be administered in amounts of less than or equal to 1.0 mg/kg per day. This includes amounts equal to or less than 0.9, 0.8, 0.7, 0.6, 0.5, 0.4, 0.3, 0.2, 0.1 mg/kg per day.
  • the Annexin A5 may also be administered in amounts of less than or equal to 0.1 mg/kg per day (e.g., less than or equal to 0.09, 0.08, 0.07, 0.06, 0.5, 0.04, 0.03, 0.02 or 0.01 mg/kg/day).
  • the agents are administered in a range of about 0.005 mg/kg per day to less than 1.0 mg/kg per day (or about 0.005 mg/kg per day to equal to or less than 0.1 mg/kg per day). In some embodiments, more than 20 mg/kg/day In some embodiments (e.g., in methods particularly directed at subjects at risk of developing an inflammatory disorder), timing of the administration of an agent comprising Annexin A5 and/or functional equivalent may be important.
  • routine schedule refers to a predetermined designated period of time.
  • the routine schedule may encompass periods of time which are identical or which differ in length, as long as the schedule is predetermined.
  • routine schedule may involve administration on a daily basis, every two days, every three days, every four days, every five days, every six days, a weekly basis, a monthly basis or any set number of days or weeks there-between, every two months, three months, four months, five months, six months, seven months, eight months, nine months, ten months, eleven months, twelve months, etc.
  • the predetermined routine schedule may involve administration on a daily basis for the first week, followed by a monthly basis for several months, and then every three months after that. Any particular combination would be covered by the routine schedule as long as it is determined ahead of time that the appropriate schedule involves administration on a certain day.
  • Polypeptides, nucleic acids, or recombinant cells described herein may be used in combination with a pharmaceutically acceptable carrier for preparation of a composition for treatment of an inflammatory disorder or treatment of organ dysfunction in an inflammatory disorder.
  • Pharmaceutically acceptable carriers are well known to those skilled in the art and include but are not limited to proteins, sugars, and the like.
  • a suitable carrier is a physiologically balanced culture medium containing one or more stabilizing agents such as hydrolyzed proteins, lactose, and the like.
  • Another example of an acceptable carrier is 0.01-0.1M, and preferably 0.05M, phosphate buffer or 0.8% saline.
  • Acceptable carriers may be aqueous or non-aqueous solutions, suspensions, and emulsions.
  • non-aqueous solvents examples include propylene glycol, polyethylene glycol, vegetable oils such as olive oil, and injectable organic esters such as ethyl oleate.
  • aqueous carriers are water, alcoholic/aqueous solutions, emulsions or suspensions, including saline and buffered media. Preservatives and other additives for pharmaceutical compositions are also well known to the skilled person, for example antimicrobials, antioxidants, chelating agents, inert gases, organic acids and the like.
  • Another example of such a suitable carrier is a biomaterial comprising natural or synthetic extracellular matrix material.
  • compositions of the invention comprising Annexin A5 may also include other pharmaceutical agents as desired for treatment of an inflammatory disorder.
  • the Annexin A5 composition may further comprise one or more antibiotics or vasopressors and/or corticosteroids as is used in the treatment of sepsis.
  • additional pharmaceuticals are selected based on the underlying condition to be treated.
  • Kits comprising polypeptides, nucleic acids, or recombinant cells described herein, in combination with a pharmaceutically acceptable carrier are contemplated.
  • Kits will typically comprise instructions for preparing a medicament comprising Annexin A5 and/or instructions for administering Annexin A5 for improving organ function in a subject suffering from an inflammatory disorder.
  • the articles “a”, “an”, “the”, and “said” are intended to mean that there are one or more of the elements unless the context dictates otherwise.
  • the term “a compound” and “at least one compound” may include a plurality of compounds, including mixtures thereof.
  • the terms “comprising”, “having”, “including” are intended to be open-ended and mean that there may be additional elements other than the listed elements.
  • the phrase “consisting essentially of” is intended to be limiting to specified elements and those further elements that do not materially affect the basic and novel characteristic of the combination of specified elements.
  • a composition defined using the phrase “consisting essentially of” encompasses any known pharmaceutically acceptable additive, excipient, diluent, carrier, and the like.
  • LPS 4 mg/kg, i.p.
  • Mice were treated with 2 injections of recombinant human annexin A5 (5 ⁇ g/kg, i.v.) immediately and 2 hours after LPS administration.
  • mice were sacrificed and hearts were isolated. Cardiac function was measured using a Langendorff heart preparation. At the end of cardiac function measurements, hearts were stored in a ⁇ 80° C. freezer for analysis of myocardial TNF expression.
  • 28S rRNA was used as a loading control using oligonucleotide primers for sense 5′ TTG AAA ATC CGG GGG AGA G 3′ (SEQ ID NO. 3) and antisense 5′ ACA TTG TTC CAA CAT GCC AG 3′ (SEQ ID NO. 4). Samples were amplified for 35 cycles using MJ Research Opticon Real-Time PCR machine. Levels of TNF mRNA relative to those of 28S rRNA were obtained similar to a previous report [9].
  • LV myocardial TNF protein levels were measured using a mouse TNF ELISA kit (Cedarlane Laboratory, Missisauga, Ontario) as described in previous reports [7, 10].
  • the LV myocardial tissues were homogenized in PBS. After centrifugation, the supernatant was collected for protein concentration and TNF ELISA. TNF measurements were standardized with protein concentrations of each sample and expressed as pg/mg proteins.
  • mice were sacrificed.
  • Mouse hearts were isolated and perfused in a Langendorff system to measure cardiac function as previously described [10]. Briefly, hearts were perfused with Krebs-Henseleit buffer at 2 mL/min constant flow. The perfusion buffer was maintained at 37° C. and bubbled continuously with a mixture of 95% O 2 and 5% CO 2 .
  • a 6-0 silk suture was placed through the apex of the left ventricle and threaded through a lightweight rigid coupling rod, which was connected to a force-displacement transducer (FT03, Grass Instrument Co.). Contractile force and heart rate were measured by PowerLab Chart program (ADInstruments, Mountain View, Calif.). The heart work was calculated by multiplying the force (g) by the heart rate (beats/min) and normalized to heart weight.
  • FT03 force-displacement transducer
  • FIG. 1 shows that Annexin A5 improves cardiac function in mice with endotoxemia.
  • Data are mean ⁇ SEM and analyzed by one-way ANOVA followed by Newman-Keul's test. *P ⁇ 0.01 vs. Sham, #P ⁇ 0.05 vs. LPS.
  • FIG. 2 shows an effect of Annexin A5 on myocardial TNF mRNA expression in endotoxemic mice.
  • TNF mRNA levels were determined by real-time RT-PCR. Data are mean ⁇ SEM and analyzed by one-way ANOVA followed by Newman-Keul's test. *P ⁇ 0.01 vs. Sham, #P ⁇ 0.05 vs. LPS.
  • FIG. 3 shows an effect of Annexin A5 on myocardial TNF protein expression in endotoxemic mice.
  • Saline treatment 100 ⁇ L, i.p
  • served as sham controls (n 4).
  • TNF protein levels were determined by ELISA. Data are mean ⁇ SEM and analyzed by one-way ANOVA followed by Newman-Keul's test. *P ⁇ 0.01 vs. Sham, #P ⁇ 0.05 vs. LPS.
  • TNF mRNA and protein expression were determined by real-time RT-PCR and ELISA, respectively. Both TNF mRNA and protein levels were significantly increased in the LV myocardium in LPS treated mice compared to saline treated sham controls (P ⁇ 0.01). Treatment with Annexin A5 significantly decreased TNF expression induced by LPS (P ⁇ 0.05).
  • FIGS. 2 and 3 show that treatment with Annexin A5 significantly decreases both mRNA and protein levels of TNF- ⁇ in the LV myocardium during endotoxemia, suggesting an anti-inflammatory effect.
  • TNF- ⁇ production is a major contributor to cardiac dysfunction during sepsis
  • reduction of myocardial TNF- ⁇ expression represents an important mechanism by which Annexin A5 improves cardiac function in the endotexemia model.
  • LPS 4 mg/kg, i.p.
  • Mice were treated with 2 injections of recombinant human annexin A5 (5 ⁇ g/kg, i.v.) immediately and 2 hours after LPS administration.
  • mice Four hours after LPS administration, mice were anesthetized with an IP injection of ketamine (50 mg/kg) and xylazine (12.5 mg/kg) mixture, and in vivo cardiac function was measured using a Millar pressure-conductance catheter. Some mice were sacrificed, blood was drawn and hearts were isolated. Ex vivo cardiac function was measured using a Langendorff heart preparation. At the end of cardiac function measurements, plasma and hearts were stored in a ⁇ 80° C. freezer for further analysis.
  • mice were anaesthetized with ketamine and xylazine.
  • a Millar pressure-conductance catheter (Model SPR-839, Size 1.4F) was inserted into the right carotid artery and advanced into the LV. After stabilization for 10 minutes, the signal was recorded continuously using a PowerLab Chart program (ADInstruments, Mountain View, Calif.). Hemodynamic parameters were analysed by a cardiac pressure-volume analysis program (PVAN 3.2; Millar Instruments, TX) as previously described (Xiang et al. Circulation. 2009, 120:1065-1074).
  • mice were sacrificed.
  • Mouse hearts were isolated and perfused in a Langendorff system to measure cardiac function as previously described (Peng et al., Circulation. 2005; 111:1637-1644). Briefly, hearts were perfused with Krebs-Henseleit buffer at 2 mL/min constant flow. The perfusion buffer was maintained at 37° C. and bubbled continuously with a mixture of 95% O 2 and 5% CO 2 .
  • a 6-0 silk suture was placed through the apex of the left ventricle and threaded through a lightweight rigid coupling rod, which was connected to a force-displacement transducer (FT03, Grass Instrument Co.). Contractile force and heart rate were measured by PowerLab Chart program (ADInstruments, Mountain View, Calif.). The heart work was calculated by multiplying the force (g) by the heart rate (beats/min) and normalized to heart weight.
  • FT03 force-displacement transducer
  • the oligonucleotide primers for TNF- ⁇ were sense 5′ CCG ATG GGT TGT ACC TTG TC 3′ (SEQ ID NO. 1); and antisense, 5′ GGG CTG GGT AGA GAA TGG AT 3′ (SEQ ID NO. 2).
  • the primers for IL-1 ⁇ were sense 5′ ACAAGGAGAACCAAGCAACGAC 3′ (SEQ ID NO. 5) and antisense 5′ GCTGATGTACCAGTTGGGGAAC 3′ (SEQ ID NO. 6).
  • 28S rRNA was used as a loading control using oligonucleotide primers for sense 5′ TTG AAA ATC CGG GGG AGA G 3′ (SEQ ID NO. 3) and antisense 5′ ACA TTG TTC CAA CAT GCC AG 3′ (SEQ ID NO. 4). Samples were amplified for 35 cycles using MJ Research Opticon Real-Time PCR machine.
  • Myocardial and plasma TNF- ⁇ protein levels were measured using a mouse TNF- ⁇ ELISA kit (Cedarlane Laboratory, Missisauga, Ontario) as described in Applicant's previous reports 8,9 .
  • the left ventricle (LV) myocardial tissues were homogenized in PBS. After centrifugation, the supernatant was collected for protein concentration and TNF- ⁇ ELISA.
  • Myocardial TNF- ⁇ measurements were standardized with protein concentrations of each sample.
  • Plasma IL-1 ⁇ protein levels were determined using an ELISA kit from eBioscience Inc, CA.
  • Phosphorylated/total p38 and ERK1/2 protein levels in heart tissues were measured by western blot analysis. Briefly, 40 ⁇ g of protein was separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Proteins were then transferred to polyvinylidene difluoride membranes and blots were probed with antibodies against p38 (1:800, Cell Signaling, Danvers, Mass.), phosphorylated p38 (Thr 180/Tyr 182, 1:800, Cell Signaling), ERK1/2 (1:800, Cell Signaling), or phosphorylated ERK1/2 (Thr 202/Tyr 204, 1:800, Cell Signaling). Blots were probed with horseradish peroxidase-conjugated secondary antibodies (1:2000; BioRad, Hercules, Calif.) and detection was performed using an ECL chemiluminescence method.
  • Cardiomyocytes were isolated from the hearts of adult WT and nNOS ⁇ / ⁇ mice. Hearts were mounted on a Langendorff apparatus and perfused with digestion buffer containing 45 ⁇ g/mL of liberase blendzyme IV (Roche). Following digestion, cells were re-suspended and exposed to a series of sedimentation and resuspension steps in buffer containing increasing concentrations of Ca 2+ (12.5 ⁇ M-1.0 mM). The rod-shaped myocytes were then plated on laminin-coated 35-mm dishes at a density of 50 cells/mm 2 and cultured for 6 hours at 37° C. in a 2% CO 2 incubator. This was followed by 4 hours of LPS (2.5 ⁇ g/ml) treatment with or without annexin A5 (1.0 ⁇ g/ml).
  • LPS 2.5 ⁇ g/ml
  • TLR4 and annexin A5 were performed using the Dynabead Protein G Immunprecipitation kits (Invitrogen, CA). Briefly, the magnetic dynabeads were suspended in an antibody-binding buffer with 20 ⁇ g of TLR4 antibody (Santa Cruz, Calif.) for 1 hour. Myocardial tissues were homogenized in NP40 cell lysis buffer and sonicated. Protein concentrations were measured using a Lowry protein assay (Bio-Rad, Mississauga, ON). Concentrations were measured to allow for equal loading of 1 mg protein per tube.
  • annexin A5 human recombinant annexin A5 (Biovision, CA) was added to the tissue samples and incubated with the TLR4-coated beads for 2 hours. The samples were eluted from the dynabeads and equally loaded on a 12% polyacrylamide gel. Western blotting was performed for annexin A5 detection using anti-annexin A5 antibody (1:2000, Biovision, CA). The membrane was stripped and reprobed for TLR4 using anti-TLR4 antibody (1:2000, Santa Cruz, Calif.).
  • mice Four hours after saline, annexin A5, LPS, or LPS plus annexin A5 treatment, mice were anesthetized and cardiac function was measured using a Millar pressure-conductance catheter. Hemodynamic parameters obtained include mean artery pressure (MAP), heart rate, left ventricle ejection fraction (LVEF), cardiac output, derivatives of left ventricular pressures (LV dP/dt max and dP/dt min ), pressure at maximal dP/dt (P@dP/dt max ), LV end systolic pressure (LVESP), LV end diastolic pressure (LVEDP), LV end diastolic volume (LVEDV), time constant of isovolumic relaxation (Tau) and maximal power (Table 2, FIG.
  • MAP mean artery pressure
  • LVEF left ventricle ejection fraction
  • cardiac output cardiac output
  • LV dP/dt max and dP/dt min derivatives of left ventricular pressures
  • annexin A5 Four hours after saline, annexin A5, LPS or LPS plus annexin A5 treatment, myocardial TNF mRNA and protein expression was determined by real-time RT-PCR and ELISA, respectively. Both TNF- ⁇ mRNA and protein levels were significantly increased in the LV myocardium in LPS treated mice compared to saline treated sham controls (P ⁇ 0.01, FIGS. 6A and 6B ). Treatment with annexin A5 significantly decreased TNF- ⁇ expression induced by LPS (P ⁇ 0.05, FIGS. 6A and 6B ). Similarly, plasma levels of TNF- ⁇ and IL-1 ⁇ were significantly increased in LPS treated mice (P ⁇ 0.01), which were significantly decreased by annexin A5 treatment (P ⁇ 0.05, FIGS. 6C and 6D ).
  • annexin A5 inhibits LPS-induced TLR4 signaling
  • interaction between annexin A5 and TLR4 receptors was studied using co-immunoprecipitation.
  • Myocardial tissues from saline and LPS-treated mice were homogenized and incubated with annexin A5.
  • Magnetic dynabeads were coated with anti-TLR4 antibody to pull down TLR4 receptors and blot for annexin A5.
  • Recombinant human annexin A5 was used as a positive control.
  • Data showed that an annexin A5 specific band in myocardial samples from both saline and LPS-treated mice, indicating an interaction between annexin A5 and TLR4 receptors ( FIG. 9 ).
  • the mouse model of endotoxemia demonstrated human annexin A5 effects on cardiac function during an LPS challenge.
  • In vivo cardiac function was determined using a Millar pressure-conductance catheter. The data showed that cardiac dysfunction induced by LPS was significantly improved after annexin A5 treatment.
  • an isolated Langendorff heart preparation was used. In agreement with the in vivo data, LPS-induced cardiac dysfunction was partially restored by annexin A5 treatment.
  • annexin A5 significantly decreased both mRNA and protein levels of TNF- ⁇ in the LV myocardium during endotoxemia.
  • plasma levels of TNF- ⁇ and IL-1 ⁇ were also decreased by annexin A5 treatment in the endotoxemic mice.
  • annexin A5 treatment inhibited TNF- ⁇ and IL- ⁇ expression in the cultured adult cardiomyocytes.
  • annexin A5 The increased p38 and ERK1/2 phosphorylation was completely abrogated by the treatment of annexin A5, demonstrating that the annexin A5 interferes with the TLR4/MAPK signaling pathway.
  • Annexin A5 may interact with the leucine rich repeats of the TLR4 receptor and inhibit LPS-induced signaling.
  • Co-immunoprecipitation to identify potential interaction between annexin A5 and TLR4 was done and the data showed that annexin A5 was co-immunoprecipitated with TLR4, suggesting an interaction between annexin A5 and TLR4 receptors. Since binding to leucine rich repeats by annexin A5 has been shown to inhibit receptor function, it is likely that annexin A5 inhibits LPS-induced TLR4/MAPK signaling through its interaction with the TLR4 receptors.
  • annexin A5 shows a novel effect of annexin A5 in a mouse model of endotoxemia.
  • Treatment with annexin A5 decreases myocardial TNF- ⁇ expression and improves cardiac function during endotoxemia.
  • These beneficial effects of annexin A5 are achieved through inhibition of TLR4/MAPK signaling via its interaction with the TLR4 receptors.
  • annexin A5 has significant therapeutic use in the treatment of sepsis.
  • MAP mean artery pressure
  • SW stroke work
  • P@dP/dt max LV pressure at maximal dP/dt
  • LVESP LV end systolic pressure
  • LVEDP LV end diastolic pressure
  • LVEDV LV end diastolic volume
  • Tau time constant of isovolumic relaxation.

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